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A Prospective Study of Long-term Intake of Dietary Fiber and Risk of Crohn's Disease and Ulcerative Colitis

      Background & Aims

      Increased intake of dietary fiber has been proposed to reduce the risk of inflammatory bowel disease (Crohn's disease [CD] and ulcerative colitis [UC]). However, few prospective studies have examined associations between long-term intake of dietary fiber and risk of incident CD or UC.

      Methods

      We collected and analyzed data from 170,776 women, followed up over 26 years, who participated in the Nurses' Health Study, followed up for 3,317,425 person-years. Dietary information was prospectively ascertained via administration of a validated semiquantitative food frequency questionnaire every 4 years. Self-reported CD and UC were confirmed through review of medical records. Cox proportional hazards models, adjusting for potential confounders, were used to calculate hazard ratios (HRs).

      Results

      We confirmed 269 incident cases of CD (incidence, 8/100,000 person-years) and 338 cases of UC (incidence, 10/100,000 person-years). Compared with the lowest quintile of energy-adjusted cumulative average intake of dietary fiber, intake of the highest quintile (median of 24.3 g/day) was associated with a 40% reduction in risk of CD (multivariate HR for CD, 0.59; 95% confidence interval, 0.39–0.90). This apparent reduction appeared to be greatest for fiber derived from fruits; fiber from cereals, whole grains, or legumes did not modify risk. In contrast, neither total intake of dietary fiber (multivariate HR, 0.82; 95% confidence interval, 0.58–1.17) nor intake of fiber from specific sources appeared to be significantly associated with risk of UC.

      Conclusions

      Based on data from the Nurses' Health Study, long-term intake of dietary fiber, particularly from fruit, is associated with lower risk of CD but not UC. Further studies are needed to determine the mechanisms that mediate this association.

      Keywords

      Abbreviations used in this paper:

      AhR (aryl hydrocarbon receptor), CD (Crohn's disease), CI (confidence interval), FFQ (food frequency questionnaire), HR (hazard ratio), IBD (inflammatory bowel disease), IQR (interquartile range), NHS (Nurses' Health Study), NSAID (nonsteroidal anti-inflammatory drug), UC (ulcerative colitis)
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      Linked Article

      • Dietary Fiber and Risk of Inflammatory Bowel Disease: Fact or Hype?
        GastroenterologyVol. 146Issue 4
        • Preview
          In our modern society, it has become a dogma that a diet poor in fruits and vegetables and high in fat and carbohydrates is the culprit behind many diseases, including inflammatory bowel disease, despite the relatively weak evidence.1 Ananthakrishnan et al in their study also enshrine this dogma in a prospective study on the long-term intake of dietary fiber in a large group of highly educated white females followed over 26 years.2 The study raises a number of questions that have been partly addressed in the accompanying editorial.
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      • Dietary Fiber Intake and Crohn's Disease
        GastroenterologyVol. 146Issue 4
        • Preview
          We read with interest, as well as some alarm, the article by Ananthakrishnan and its accompanying editorial by Kaplan in the November 2013 issue of Gastroenterology.1,2 These authors suggest that increased dietary fiber intake, specifically from fruits, may have a protective effect on development of Crohn's disease (CD) but not ulcerative colitis. They postulate 2 potential mechanism, including changes in the composition of the microbiota and increased fermentation of fiber from fruit into short chain fatty acids leading to decreased proinflammatory mediators, as well as increased activation of the aryl hydrocarbon receptor leading to improved protection against environmental insults.
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